Revision ACL Surgery
The majority of ACL reconstruction surgeries are successful and allow a return to high level athletic activity. Unfortunately, there are some re-injuries and failures of ACL grafts. Young competitive athletes are at higher risk for recurrent injury and appear to be at increased risk when allograft (cadaver graft) was used for the initial surgery. Surgical technique can also play a role in failures including placement of the ACL graft in a non-anatomic position. ACL dependent sports such as soccer, football and basketball will always involve risk of recurrent ACL tear. Despite great success and new advances with ACL surgery, the replacement ACL graft will never be quite as good as the native uninjured ACL.
Revision ACL surgery is often more complex than primary ACL reconstruction. Tunnels previously drilled in the femur and tibia may not be in the desired position for anatomic ACL reconstruction and may have been a factor in failure of the original surgery. Tunnels may also have widened over time which can make adequate fixation of the ACL graft more difficult. Sometimes these issues can lead to the need for a two stage revision surgery. Two stage surgery typically involves bone grafting the original tunnel sites and returning for a second surgery months later to place the new ACL graft.
Graft options for revision ACL reconstruction include patellar tendon and hamstring autografts as well as several allograft options. Allograft options are more likely with revision surgery depending on what graft source was used for the original ACL surgery. Use of autograft if feasible is still recommended by Dr. Burris, particularly for younger athletes as described in graft options under ACL Tear.